Determinants of practice patterns in pediatric UTI management

Area of Science:

• Pediatrics
• Infectious Diseases
• Clinical Practice Guidelines

Background:

• Urinary tract infections (UTIs) are common in children, affecting 10% of girls and 3% of boys by age 16.
• Guidelines recommend urine testing and local antibiograms for empiric antibiotic therapy in pediatric UTIs.
• Challenges exist in implementing these guideline recommendations.

Purpose of the Study:

• Investigate practice patterns for urine testing and antibiogram use in pediatric UTI management.
• Identify factors influencing adherence to UTI management guidelines.
• Inform targeted interventions to improve guideline implementation.

Main Methods:

• National survey of physicians caring for children.
• Data collected on practice type, urine testing, specimen collection, and antibiogram utilization.
• Logistic regression analyzed factors associated with testing and antibiogram use.

Main Results:

• 84% of physicians obtain urinalysis and culture before UTI treatment.
• Urine collection by bag is prevalent, often due to difficulty or refusal of catheterization.
• Only 50% of physicians with antibiogram access use it for empiric antibiotic selection.

Conclusions:

• Most practitioners obtain urine tests but rely on less optimal collection methods.
• Adherence to guideline recommendations for empiric antibiotic selection using antibiograms is suboptimal.
• Interventions should focus on improving catheterization, parental education, and EMR integration of antibiograms.